| Background and purposeAnti-neutrophil cytoplasmic antibodies associated with vasculitis(AAV)is a autoimmune disease involving multiple systems of the body.When the kidney is involved,the pathological type is mainly focal segmental glomerular capillaries necrosis and/or crescent formation.When ANCA associated vasculitis involves the kidney,it often presents with rapidly progressive glomerulonephritis syndrome,abrupt onset,rapid disease progression,poor prognosis,and high recurrence rate.Therefore,ANCA associated vasculitis with renal involvement patients need long-term maintenance treatment after induction therapy is relieved.The purpose of maintenance treatment is to control the disease does not have a relapse for a long time,and while performing treatment,it can reduce the therapeutic drug-related adverse reactions and protect renal function.So far,the most common maintenance treatment for ANCA associated vasculitis with renal involvement is low-dose glucocorticoids combined with cyclophosphamide,but due to the accumulation of therapeutic doses of cyclophosphamide(CTX),toxic side effects continue to increase.Adverse reactions such as secondary infection,myelosuppression,tumor,hemorrhagic cystitis may occur,so new immunosuppressive agents need to be sought for maintenance treatment of ANCA associated vasculitis with renal involvement patients.Mycophenolate mofetil(MMF)is a new immunosuppressive agents that selectively inhibits T and B lymphocytes proliferation.In recent years,clinical studies at home and abroad have reported the successful application of MMF in the induction and maintenance treatment of ANCA associated vasculitis with renal involvement patients.However,there is little clinical controlled study of MMF and CTX in the maintenance treatment of ANCA associated vasculitis with renal involvement patients.Therefore,this study retrospectively analyzed the efficacy and safety of low-dose glucocorticoids combined with MMF and CTX for maintenance treatment in ANCA associated vasculitis with renal involvement patients,thus providing new evidence and reference for the long-term maintenance treatment of immunosuppressive agents in ANCA associated vasculitis with renal involvement patients.MethodThe clinical data of 36 patients with ANCA associated vasculitis with renal involvement were retrospectively analyzed.All patients received a standard induction therapy of glucocorticoids and cyclophosphamide,which achieved remission and entered maintenance treatment.The patients were divided into MMF group(17 cases)and CTX group(19 cases)according to patients' maintenance treatment medicine.24 hour urinary protein quantity and serum creatinine were collected from all patients before maintenance treatment,6 months of treatment,and 12 months of treatment,and survival analysis was performed with death or end-stage renal disease(ESRD)as the end point event.We calculated the 1-year human and renal survival rate of the two groups of patients,and recorded the occurrence of adverse reactions during the maintenance treatment period of the two groups of patients.Result1.There was no significant difference in 24 hour urinary protein quantity and serum creatinine between the two groups before maintenance treatment(P > 0.05).There was no significant difference in the 24 hour urinary protein quantity between the two groups at 6 months after treatment(P > 0.05),while the serum creatinine in the MMF group was lower than that in the CTX group,the difference was statistically significant(P <0.05).After 12 months of treatment,there was no significant difference in 24 hour urinary protein quantity between the two groups(P > 0.05),Compared serum creatinine between the two groups,the difference was statistically significant(P <0.05).After 12 months of treatment,the 24 hour urinary protein quantity was lower than that before treatment,the difference was statistically significant(P <0.05).The serum creatinine in the MMF group was lower than that before treatment,the difference was statistically significant(P <0.05),CTX group serum creatinine was higher than that before treatment,but the difference was not statistically significant(P > 0.05).2.During the maintenance treatment period,17 patients in the MMF group,3 died of pulmonary infection and 3 entered ESRD.The 1 year patient and renal survival rates ware 82.4%.19 patients in the CTX group,5 died of pulmonary infection and 10 entered ESRD.The 1 year patient and renal survival rates were 73.7% and 47.4%.There was no significant difference in the 1-year survival rate between the two groups(P > 0.05),but the 1 year renal survival rate in the MMF group was higher than that in the CTX group,the difference was statistically significant(P <0.05).3.During the maintenance treatment period,3 of the 17 patients in the MMF group developed pulmonary infection,the incidence rate was of 17.6%.19 patients in the CTX group,10 had pulmonary infection,2 had leukopenia,and 2 had elevated transaminases,the incidence rates were 52.6%,10.5%,and 10.5%.The incidence rate of pulmonary infection in the MMF group was lower than CTX group,the difference was statistically significant(P < 0.05).ConclusionLow-dose glucocorticoid combined with MMF or CTX can effectively maintain the remission of ANCA-associated vasculitis with renal involvement patients.The application of MMF has better tolerance and renal protection,and fewer adverse reactions. |
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